347005239-10-6-2022-27-AS-KHOS-CKCTF9-20221019144111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005239
Report Date: 10/06/2022
Date Signed: 10/06/2022 11:27:54 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20220912160640

FACILITY NAME:	GREENHAVEN ESTATES		FACILITY NUMBER:	347005239
ADMINISTRATOR:	MALISSA ACUNA		FACILITY TYPE:	740
ADDRESS:	7548 GREENHAVEN DR		TELEPHONE:	(916) 427-8887
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	105	CENSUS: 53	DATE:	10/06/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Malissa Acuna		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff yelled at resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conclude the complaint investigation on 10/6/2022 at 9am. LPA met with Malissa Acuna, Administrator and stated the purpose of the visit. LPA reviewed Resident #1 (R1)'s physician report (LIC602) dated 8/19/22 which does not indicate that R1 has a diagnosis of dementia nor mild cognitive impairment. LPA also reviewed the facility Investigation documents that did not indicate personal rights violations occurred. The investigation revealed that R1 reported to S1 and Law Enforcement about being pushed and yelled at initially by S4 on 9/9/22. On the following day, R1 named several staff (S2-S4) as abusers. S1-S4 was interviewed. R1 recanted each named staff to Administrator, Health Services Director and LPA and stated the inability to recall the incident. Based on interviews and lack of evidence the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion: 60

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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